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Closing of large pharyngostomes with free flaps and proposal of a new classification

  • Head and Neck
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

Large pharyngocutaneous fistulas or pharyngostomes are difficult complications to solve, which generate high morbidity and mortality, a poor quality of life and an increase in health costs. Its management must be comprehensive according to general, local and regional factors. We review our experience in treating these pharyngostomes with free flaps.

Methods

Retrospective study analyzing the results of the reconstruction of 50 patients using free flaps during the period 1991–2019. We exclude patients who required free-flap reconstruction due to primary tumor or those who resolved in other ways. The different types of reconstruction were classified into three types.

Results

The 86% (43) were men, and the mean age was 57 years (25–76). In 48% (24/50) the flaps performed were anterolateral thigh (ALT), in 24% (12/50) forearm, in 22% (11/50) parascapular, in 4% (2/50) jejunum and in 2% (1/50) ulnar. A salivary by-pass was placed in 74% (37/50) of the cases. Four cases (8%) presented flap necrosis and two patients died due to treatment. In 86% (43/50) there was some type of complication and 34% (17/50) required surgical revision. 94% (45/48) were able to reintroduce oral feeding.

Conclusion

According to our experience, we proposed a regardless size classification: type 1 when only a mucous closure (pharynx) are required (6%), type 2 exclusively skin for cutaneous coverage (10%) and mixed type 3 (mucous and skin) (84%). The treatment of large pharyngostomes with free flaps, despite its complexity, is in our experience the best option for its management.

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Funding

The present investigation has not received specific aid from public agencies, commercial or non-profit entities.

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Authors and Affiliations

  1. Department of ENT, Hospital Universitario Central de Asturias, C/Avenida de Roma s/n, 33011, Oviedo, Spain

    J. L. Llorente, P. Sánchez, F. López, R. Charlone, J. P. Rodrigo & C. Álvarez-Marcos

  2. Department of Plastic Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain

    D. Camporro & A. Fueyo

Authors
  1. J. L. Llorente
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  2. P. Sánchez
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  3. F. López
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  4. D. Camporro
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  5. A. Fueyo
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  6. R. Charlone
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  7. J. P. Rodrigo
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  8. C. Álvarez-Marcos
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by PS and JLL. The first draft of the manuscript was written by JLL and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to P. Sánchez.

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Llorente, J.L., Sánchez, P., López, F. et al. Closing of large pharyngostomes with free flaps and proposal of a new classification. Eur Arch Otorhinolaryngol 277, 3137–3144 (2020). https://doi.org/10.1007/s00405-020-06010-x

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  • DOI: https://doi.org/10.1007/s00405-020-06010-x

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